| NPI | 1851584122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10882) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MN 10504) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2023-10-05 |